Is Dallas County's most explosive bureaucrat ruining the health department?

But life under Culbreath is no honeymoon. Two weeks into her new position, Culbreath issued a memo-ultimatum to the troops that made it clear who was in charge--and who wasn't. "DO NOT GIVE ANY INFORMATION TO ANY MEDIA PERSONS REGARDING HEALTH AND HUMAN SERVICES," Culbreath wrote in the one-page memo to staff. Only doctors were allowed to speak to the press, she stated.

Culbreath tightened the leash on her employees again on November 8, 1996, when she ordered that all outgoing correspondence must first be reviewed by Zachary Thompson, the former human services operations manager, who Culbreath promoted to be her deputy director and spin doctor.

"Recently, correspondence went out with grammatical and spelling errors. This type [sic] activity is unacceptable as it reflects on the Department," Culbreath wrote, overlooking her own grammatical error. "Mr. Thompson will ensure that correspondence is correct and return it to the individual submitting the information following his perusal."

In those early weeks, if anything was clear, it was that Culbreath was calling the shots and nobody should bother to ask why. In signing off on one memo, Culbreath wrote: "Your cooperation is mandatory."

When Culbreath subsequently instituted her big departmental reorganization--eliminating six positions, while promoting two Price-Culbreath acquaintances--the rank-and-file in the health department began buzzing. There had been no warning, no meetings. Just a memo from the boss.

Culbreath didn't bother to gather input from anybody in the department, either, including the medical staff.

"I don't know of anyone who was involved in those discussions other than the commissioners and Ms. Culbreath. We were told what happened, and that was that. There was no input from us," says Dr. Haley.

Former TB program manager Charla Edwards, whose position was eliminated by Culbreath, echoed Haley's comment.

"There was no communication to the program managers. We had no indication that our jobs were being eliminated. We were called in and told," Edwards said in January, before she left the department to take a job at Parkland. "Everybody is in shock. It's all politics."

Culbreath's surprise reorganization--and the subsequent in-house buzz--prompted Culbreath to shoot off another tough-love memo. "The gossip must stop," the missive stated. "The merger is complete and any attempt to damage the Dallas County Health and Human Services Department or its reputation will result in violation of Dallas County policy and procedures. Discipline measures will be taken."

Reorganizations take place every day in the public sector. Sometimes employees like them; often they don't. But they generally don't become big news outside of that department--unless, of course, the boss is inexplicably threatening to cut fingers off the unhappy. Therefore, it should not have come as a surprise to anyone--least of all Culbreath--when the malcontents began quietly talking to the press, in direct violation of the boss' orders.

On Christmas Eve, The Dallas Morning News printed a lengthy article about the "quiet reorganization" of the health department. Instead of merely explaining what she was doing, Culbreath recoiled, accusing nearly everyone under her of being misfits and incompetents, and calling in her favorite political pit bull to defend her honor. "The work product out there was horrible," John Wiley Price told the Morning News. "We don't need a lot of people sitting around drinking coffee and taking smoke breaks...that was happening all the time."

Culbreath piled on, claiming that "people were not doing any work."
Today, when Culbreath is asked a simple question--Is there some reason why she didn't discuss the reorganization with Haley or any other staff members?--her response is vintage Betty Culbreath.

"But who in the hell?" she says exasperatedly. "Listen here, honey. Listen baby, sugar, honey. When you go on a job, do you tell your boss what you supposed to do or do your boss tell you what you're supposed to do?"

Parkland's Ron Anderson says the merger of health and human services ultimately could be beneficial, because the new structure would allow the politically astute Culbreath to act as a buffer between the department and the increasingly conservative commissioners court.

But Anderson adds that the structure will only work if Culbreath hires a strong medical director and empowers that person to make independent medical decisions.

"It's like running a hospital," he says. "Very few hospitals have a physician CEO. Those that do not, though, need to have a very, very strong medical director. And they need to work as a partner, not as a subordinate-superior type relationship. They need to work together as colleagues."

Culbreath's decision publicly to accuse her predecessors of incompetence only makes matters worse. Besides, Anderson says, it makes no sense from a management perspective.

"I said [to Culbreath], 'If you're looking to rationalize this [the reorganization], do it some other way. Don't make people look like they've been bad people after all these years they've given to Dallas County,'" Anderson says. "When I do a job elimination, I do it because I have done a job study. When you're talking about somebody's work productivity, you have to know what the work product is supposed to be."

Last month, Anderson says, he was pleased when Culbreath asked him to tour some of the department's community-based clinics and invited him to serve on a selection committee for a new medical director. The gesture was a "positive sign" that Culbreath is breaking the silence between her administration and the medical community. Even so, Anderson says, Culbreath needs to focus on developing a long-term health plan for the county.